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THE EPIDEMIC OF CHILDREN WHO KILL:
SHOULDN'T MANAGED CARE HAVE TO SHARE IN THE BLAME?
 
  By David Kirschner, Ph.D.

First, Kip Kinkel, only 14 years old, killed his parents. Then he murdered two students and wounded 25 others at an Oregon high school last year.

Why do children kill?

While there are no simple answers, it is tempting, nonetheless, to note the red flags scattered everywhere. Perhaps the parents should have seen it; perhaps the school. Yet, what can be expected when parents purchase high-powered guns for an angry son?

But there is yet another aspect, glaring to me but generally unpublicized and ignored.

It is the toxic role of HMOs and managed care companies in this seeming epidemic by children to kill.

A recent U.S. News and World Report article (March 20, 2000) questions whether powerful psychoactive drugs are safe for children, and explores how these prescriptions can spark acts of violence. The article touches on the issue of practitioners being pressured by managed care organizations and insurers to avoid referring children patients for "costly" psychotherapy, and pushing instead for quick-fix solutions, to children's mental health problems.

  Kinkel, as most of the other school killers, had been in treatment prior to the high profile event that brought his story to public attention.

But why was this "treatment" so unsuccessful? Jeffrey Hicks, Ph.D. provides pre-sentencing testimony (which can be found at PBS.com). These documents should be studied for the valuable clues they offer about how not to treat troubled, potentially violent children - and hopefully, what can be learned about how to prevent such tragedies in the future.

Hicks' treatment plan follows a classic "managed care- friendly" format, conforming to the insurance companies' protocols which are to maximize profits while reducing sessions at the expense of the patient's psychological, emotional and real treatment needs. For example, Kip was seen only nine visits over a six-month period in 1997. HMOs and MCOs often limit or certify no more than 10 visits per calendar year.

Kip was referred for treatment because of a number of serious symptoms including depression, angry acting-out, a very troubled relationship with his father, and playing around with explosives (setting off home-made bombs when upset).

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